Assessing the oncologic risk when systematic and multiparametric magnetic resonance imaging-targeted prostate biopsy grade groups are discordant.
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Scuderi Simone, Targeted Biopsies Prostate Cancer Collaborative Group, Tin Amy L, Marra Giancarlo, Bianchi Lorenzo, Kesch Claudia, Soeterik Timo F W, Ploussard Guillaume, Zattoni Fabio, Ettala Otto, Røder Andreas, Poyet Cédric, Müntener Michael, Umbehr Martin, Stroomberg Hein Vincent, Cimmino Umberto, Fiard Gaelle, Nordström Tobias, Patel Hiten D, Gupta Gopal N, Yonover Paul M, Guillaume Benedicte, Gaffney Cristopher, Zhuang Junlong, Wang YanQin, Sarkis Julien, Jabbour Teddy, Diamand Romain, Windisch Olivier, Olivier Jonathan, Abbadi Ahmad, Kim Eric H, Wang Johnny C, Hu Jim, Zhu Alec, Stabile Armando, Eastham James A, Montorsi Francesco, Briganti Alberto, Gandaglia Giorgio, European Association of Urology (EAU) Young Academic Urologists YAU Prostate Cancer Working Party, Vickers Andrew J
Аннотация
METHODS: Overall, 6588 patients received systematic biopsy plus MRI-targeted biopsy and radical prostatectomy. We assessed advanced stage (seminal vesicle or lymph node invasion with or without extraprostatic extension), adverse pathology (advanced stage or high grade group), and biochemical recurrence for each systematic biopsy and MRI-targeted biopsy grade group combination.
RESULTS: Overall, 3405 (52%) had discordant grade groups. When systematic biopsy and MRI-targeted biopsy grades were discordant, the risk of advanced-stage disease was intermediate. For instance, the risk of advanced pathologic stage was 23% for grade group 3 on both systematic biopsy and targeted biopsy and 8.8% for concordant grade group 2. The risk was 18% for patients with systematic biopsy grade group 3 but targeted biopsy grade group 2 and 15% if the reverse were true. Similar results were seen for other outcomes.
CONCLUSIONS: When the grade group is discordant between systematic biopsy and targeted biopsy, the risk is intermediate. The current approach of assigning the highest grade group should be abandoned, and urologists should consider deescalating treatment intensity for patients with discordant systematic biopsy and MRI-targeted biopsy grade groups. Our findings are plausibly explained by pattern 4 volume being the primary driver of risk.